Response to Intervention
(RTI)
2014-2015 Handbook
Form Last Updated July 2014
RTI PCSS Form 12
2
Contents
Mission Statement................................................................................................................................................................... 4
Putnam County Charter System Board Goals .................................................................................................................... 4
Response to Intervention Introduction .................................................................................................................................... 4
Core Principles of RTI........................................................................................................................................................ 4
Response to Intervention Definition ................................................................................................................................... 4
Major Components …………………………………………………………………………………………………..…4-5
Putnam County Charter School System Tiered RTI Model.................................................................................................... 6
Tier 1: Common Core, or Benchmark, Level .................................................................................................................... 7
Tier 2: Supplemental, or Strategic, Level .......................................................................................................................... 7
Tier 3: Intensive Level....................................................................................................................................................... 7
Tier 4: Special Needs......................................................................................................................................................... 8
RTI in Practice.................................................................................................................................................................... 8
Key Components..................................................................................................................................................................... 9
Problem-Solving Team ....................................................................................................................................................... 9
Problem-Solving Process ………………………………………………………………………………………………..10
Progress Monitoring ......................................................................................................................................................... 10
Curriculum Based Measurement .................................................................................................................................... 111
Pre, Post and Benchmark Assessments ............................................................................................................................ 11
Data-Based Decisions ....................................................................................................................................................... 11
Setting Ambitious and Realistic Goals ............................................................................................................................. 12
Trend line or Gap Analysis…………………………………………………………………………………………...12-13
Instruction & Intervention……………………………………………………………………………………………13-
134
Instruction and Intervention Factors to Consider at all Tiers ........................................................................................... 14
Implementation of RTI.......................................................................................................................................................... 14
Tier 1................................................................................................................................................................................. 14
Tier 2.................................................................................................................................................................................14
Tier 3................................................................................................................................................................................. 15
Tier 4.................................................................................................................................................................................15
Special Considerations in RTI .............................................................................................................................................. 16
Gifted & Talented & EL’s ................................................................................................................................................ 16
Students with Individual Education Plans ........................................................................................................................ 16
Referral for Individual Evaluation for Special Education Services .................................................................................. 16
KEY TERMS & ACRONYMS ……………………………………………………………………………..….17-21
Appendices:
A. PCCSS Forms Sample Reading Pyramid …………………………………………………………………………..22
Sample Math Pyramid ……………………………………………………………………………...23
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Sample Behavior Pyramid ………………….....................................................................................24
PCCSS Form 1 Proficiency Plan & Progressing Monitoring (two pages) …………………..…25-26
PCCSS Form 2 Gap Analysis…………………..…………………………………………………. 27
PCCSS Form 2 Gap Analysis (Sample) ………….………………………………………………. 28
PCCSS Form 4 Pre-K/Head Start/K monitoring ………………………………………………..…29
PCCSS Form 5 Parent Contacts……………………………………………………………………30
PCCSS Form 6 Administrative Data (for private school use) ……………………………………. 31
PCCSS Form 7 Observation ……………………………………………………………….........32-33
PCCSS Form 8 Work Sample Cover Sheet ……………………………………………………… 34
PCCSS Form 9 SST Meeting Summary Template … ……………………………………………. 35
PCCSS Form 10 SST Meeting Summary (blank) ………………………………………………… 36
PCCSS Form 11 Referral Form (private schools) …………………………………………… 37-39
PCCSS Form 12 Social History (also available in Spanish)..………………………………… 40-41
PCCSS Form 13 Checklist pre-k/Head Start………………………………………………….. 42
PCCSS Form 14 Checklist initial referrals …………………………………………………… 43
PCCSS Form 15 Checklist re-evaluations ……………………………………………………. 44
PCCSS Form 16 Checklist (private schools) …………………………………………………. 45
PCCSS Form 17 Informal Adaptive Report ....………………………………………………. 46
PCCSS Form 18 Screening Checklist ………………………………………………………..… 47
PCCSS Form 19 504 Checklist ………………………………………………………………… 48
PCCSS Form 20 Medical Evaluation Report …………………………………………………. 49
PCCSS Form 21 Communication Form ………………………………………………………. 50-51
PCCSS Form 22 Screening Permission ……………………………………………………….. 52
PCCSS Form 23 504 Eligibility Consideration/Eligibility ……………………………………..53-56
PCCSS Form 28 Physician Letter ……………………………………………………………… 57
PCCSS Form 29 Authorization to Release …………………………………………………….. 58
PCCSS Form 30 Permission to do hearing/vision screening …………………………………..59-60
PCCSS Form 31 Authorization to Receive ………………………………………………………61
PCCSS Form 33 PT/OT Referral Form ………………………………………………………….62
PCCSS Form 34 Special Education Data Collection/Progress Monitoring………………………63
PCCSS Form 36 Functional Behavior Assessment ……………………………………………64-65
B. Web Resources …………………...…………………………………………………………………66
C. RTI In Action (flowchart) …………………………………………………………………............67-69
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Mission Statement The mission of the Putnam County Charter School System is to assist all students in acquiring knowledge, fostering aspirations,
and developing life skills that will empower them to become self-directing, productive contributing members of a global society.
Putnam County Charter System Board Goals Goal One: To ensure high levels of performance for all students in Putnam County
Goal Two: To ensure fiscal responsibility and effective resource stewardship Goal Three: To develop leadership and staff capacity throughout the system
Goal Four: To actively engage students, parents and community stakeholders
Response to Intervention (RTI) Introduction Core Principles of RTI RTI is grounded in the belief that ALL students can learn and achieve high standards when provided with effective teaching, research-based instruction, and access to a standards-based curriculum. A comprehensive system of tiered
interventions is essential for addressing the full range of students’ academic and behavioral needs. Collaboration among
educators, families, and communities is the foundation of effective problem solving, and on-going academic and
behavioral performance data should inform instructional decisions. Effective leadership at all levels is crucial for RTI
implementation.
Response to Intervention Definition RTI is an integrated approach that includes general, remedial, gifted, ESOL and special education in providing high- quality instruction that is matched to individual student needs. It is based on a four-tiered model that monitors student
progress with different levels of intervention intensity. By providing scientifically-based intervention to students,
monitoring progress on interventions, and using this information to determine which students are in need of more
intensive services, RTI further builds on the requirements of the Elementary and Secondary Act (ESEA). The Individuals
with Disabilities Education Act (IDEA) 2004 requires utilizing the RTI process as an alternative approach for the
identification of students with learning disabilities.
Major Components 1. Leadership: Leadership at the state, district, and building level is crucial to the fidelity of RTI implementation. It
is important to establish a long-term commitment to resources and time, as well as moving the focus of RTI from
philosophical understanding to actual practice. The impact of RTI involves significant systematic changes which
need to be supported throughout implementation at all levels.
2. Curriculum & Instruction: RTI involves a tiered system of interventions designed to meet the needs of all
students. A strong curriculum based on state and national standards and high-quality instruction are essential. 3. School Climate & Culture: A positive school climate provides the foundation on which instruction will occur
and all students will be engaged in learning. Positive Behavior Intervention Supports (PBIS) provide systematic
strategies for achieving important social and learning outcomes, while preventing problem behavior with all
students.
4. Problem-Solving Process: The purpose of the problem-solving process is to provide a decision-making process
that will lead to the development of instructional and intervention strategies with a high probability of success.
The system must integrate the use of data, both to guide the development of effective interventions and to provide
frequent monitoring of progress. 5. Assessment/Progress Monitoring: Using reliable and on-going data to drive the decision-making process for
individual students at all grade levels is a major component of any RTI system. There are four types of
assessment:
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a. Benchmarks: Benchmarks are quick (1-5 minute) measures of overall ability and critical skills known to
be strong indicators that predict student performance. Screenings are administered to all students, usually
three times per year.
b. Progress Monitoring: Progress monitoring (PM) are brief (1-5 minute) measures used to determine
whether students are making adequate progress. PM provides information on the effectiveness of
instruction and whether to modify the intervention. Progress monitoring is often done frequently, at least
once per week. This progress is demonstrated graphically on the GAP Analysis Form (Form # 2, 3, or 23)
depending on the area of need (see Appendix A).
c. Diagnostic: Relatively lengthy (30-90 minutes), diagnostic assessments provide an in-depth assessment
of targeted skills. These are formal instruments that break down individual student strengths and
weaknesses in a particular skill area. Diagnostic assessments are administered less frequently and often to
those students who struggle the most.
d. Summative Assessments: The state assessments are given as prescribed by the state and are administered
in groups. This data is used for school, district, and/or state accountability purposes. These assessments
give information about the overall effectiveness of instructional programs.
6. Community Involvement: When families, schools, and communities work together, children have a greater
chance for success. Forming collaborative partnerships with families and communities is more than simply
working together; it involves working together to achieve mutually desired, specifically outlined outcomes.
7. Special Education and RTI: IDEA 2004 states, “when determining whether a student has a specific learning
disability ... a local educational agency shall not be required to take into consideration whether a student has a
severe discrepancy between achievement and intellectual ability" ... a school "may use a process that determines if the student responds to scientific, research-based intervention as part of the evaluation procedures ..." (Section 1414(b)(6)). The Georgia Department of Education.
a. Prior to, or as a part of the referral process, the student is provided appropriate, relevant research-based
instruction and intervention services in regular education setting, with the instruction provided by
qualified personnel; and
b. Data-based documentation of repeated assessments of achievement and/or measures of behavior is
collected and evaluated at reasonable intervals reflecting systematic assessment of student progress during
instruction; the results are then provided to the students’ parents.
c. If the student has not made adequate progress after an appropriate period of time during which the
specified conditions have been implemented, a referral for comprehensive evaluation shall be considered,
followed by an eligibility meeting to determine if the student needs special education and/or related
services
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Putnam County Charter School System Tiered RTI Model (Each school shall have a school-specific pyramid of interventions – see Appendix A pages 22-24)
More than one intervention should occur at Tiers 2 and 3 if the initial intervention proves unsuccessful.
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Tier 1: Common Core or Benchmark Level (see examples of all forms in Appendix A)
Definition: Standards-aligned instruction and school-wide foundational interventions are provided to all students in the
general education setting using the Common Core Georgia Performance Standards (CCGPS) and researched interventions
established at the various school levels. Tier I is also used to identify students who are making expected grade level
progress (benchmark students) and demonstrating social competence in the standards-aligned system.
Tier 1 includes the curriculum, the core program, and the instruction that goes on in the regular classes; universal
screening; and any other supplemental materials that are used with the core program or to support the curriculum.
Instruction should be taking place at Tier 1 in such a way that it helps 75 to 80% of the student population meet grade-
level standards. In other words, if a data review indicates that more than 25% of students seem to need Tier 2, Tier 3 or
Tier 4 interventions, then changes need to be made to Tier 1.
All students will receive instruction in an empirically supported core curriculum (CCGPS)
According to research, typically, about 80% of students in a school will respond to a high-quality core curriculum
and will make adequate progress throughout the year
Progress of all students is monitored at three to four points in time with “pre and post test” or “benchmarks,”
during the Fall, Winter, and Spring of each school year. In addition to pre and post test assessments, the district
will utilize results from SRI (Scholastic Reading Inventory), DIBELs, NEXT, STAR Reading, and STAR Math.
Benchmark data indicate students who are not responding adequately to the core curriculum and who are in need of additional instruction
Positive Behavior Intervention Supports (PBIS) is the system wide support adopted by the district to develop
social competence and a framework for a positive approach to discipline.
Tier 2: Supplemental or Strategic Level Tier 2 includes standards-aligned instruction with supplemental, small group instruction, which may include specialized
materials. Tier 2 services are generally provided inside the regular classroom. However, in some cases this may not be
appropriate. Tier 2 is provided in addition to Tier 1. In other words, students still attend and complete the work from
the regular class. The selected interventions are provided in addition to the regular class and include:
Students who do not respond adequately (in a manner meeting promotion criteria) to the core curriculum based on
benchmark assessments
A student intervention plan which is documented on PCCSS Form 1 (Proficiency Plan with regular reviews)
A smaller group of students – Approximately 15% of the students in a school
Students who are considered “at-risk”
Students who are provided supplemental instruction/intervention (in addition to the core curriculum), which takes
place about 2-3 times per week and often in small group formats using standard protocol interventions
More frequent progress monitoring: at least once weekly for at least two to three weeks (each separate
intervention should have two to three data points to show progress was monitored and documented on PCCSS
Forms 2, 3, or 4 - Gap Analysis) With parent permission, Tier 2 staff may also request a targeted screening to
identify specific needs and possible interventions. Most students at this level will make sufficient progress at this level and are “returned” to the Tier I level To be determined by each school, students with At Risk levels of social competence will be referred to the School
Counselor, CICO, or HUG club. Each administrator in conjunction with their PBIS committee will determine the
level of referrals to be referred to Tier 2 intervention. Parent contacts are ongoing and are documented on PCCSS
Form 5.
Tier 3: Intensive Level (Student Support Team) Tier 3 is also in addition to Tier 1. Therefore, a student who receives Tier 3 interventions/support also receives Tier 1
support (everything that occurs in the regular class). At the Tier 3 level, the student is added to the SEMS data base as
a Tier 3 student. This level includes:
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Teachers submit documentation to the designated RTI Coordinator to include:
Work samples –PCCSS Form 8
Copies of all Tier 2 Proficiency Plans and Gap Analysis forms
Students who do not respond adequately to core curriculum or Tier 2 strategic level interventions
Not more than approximately 5% of the students in a school who are considered in need of intensive intervention
High-quality, research-based interventions provided individually or in small groups (1:1-1:3 teacher to student
ratio; interventions and decision making is documented on PCCSS Form 1-Proficiency Review Plan)
An individualized problem-solving model to drive instruction With parent permission, Tier 3 staff may also
request a targeted screening to identify specific needs and possible interventions.
Student progress monitored more frequently: 1 to 2 times/week and documented on PCCSS Form 2, 3, or 4)
Changes made to the student’s intervention plan based upon his/her progress toward a specified goal
Students with continued At Risk social competence will increase counseling time and a conference with parents
for possible recommendation for referral to outside agency.
Students who make adequate progress at this level are returned to Tier II or Tier I level
For students who do not make adequate progress (in a manner meeting promotion criteria) at this level, RTI
Coordinator will:
Submit a request for review to the School Psychologist who will add the student to the SEMS data base
Complete SEMS administrative data form Use SEMS meeting summary & attendance for documentation for all meetings
Use SEMS for documenting intervention planning & monitoring
Complete SEMS eligibility tabs 1 through 4 Request PCCSS Form 12 – Social History) and complete PCCSS Form 21 – Communication
& upon approval obtain parent permission (SEMS), request a classroom observation (PCCSS Form 7),
and complete the appropriate checklist (PCCSS Form 13 or 14).
Tier 4: Special Education/Specialized Instruction Tier 4 applies to students who meet who meet eligibility criteria for specialized instruction. Tier 4 may include gifted
education services, ESOL, and/or special education and related services for eligible students. Within the school
community, it applies to the parents of students receiving specialized services. Parents have certain rights and are invited
to attend meetings, are part of the planning process, and as a member of the Eligibility Committee help determine what
services, accommodations, and testing settings are needed. For special education this includes an IEP meeting, for ESOL
students a Language Assessment Conference, and for Gifted students a Placement & Eligibility Team meeting.
At this level a system of procedures are put in place to make sure students are given the highest level of intervention and
receive specialized instruction based on the individual needs of the students.
RTI in Practice There are three key features of RTI:
Scientific or research-based instruction and intervention;
Assessment of the effects of instruction (i.e., student response data based on frequent progress monitoring); and Data-based decision making (i.e., using the student response data as the basis for decision making).
Each feature is part of an interrelated process which should be applied to every student. Instructional practices are
evaluated and adjusted based on results of reliable, valid, and sensitive indicators of important student outcomes. If any
piece is missing, the process breaks down.
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Data-based
decision making
Scientific- research based instruction and
intervention
Assessment that is sensitive to instructional
effects
RTI represents a fundamental shift in how schools will go about identifying and responding to students’ academic difficulties. Therefore, it is important to understand what RTI is and what it is not. RTI is more about what will be done
than where it will be done. Also, it is more about how the job will get done and less about who will get it done. RTI
requires educators to change how they view student difficulties and disabilities. RTI procedures turn attention away from
identifying deficits within the student (e.g., processing difficulties) and toward evaluating student progress over time on
the basis of age-based comparisons and rates of learning. Therefore, students’ academic performance is compared to the
performance of other students in their school or district and student learning is evaluated based on how quickly that
student acquires instructed material. The effect of this shift is that it forces educators to focus on how much and what types
of instruction students need, which increases accountability for student learning.
RTI is… RTI is not…
About instruction Just about interventions
An initiative that supports general education
school improvement goals
A pre-referral system for special education
A method to unify general and special education in order to benefit students through a
greater continuity of services
An individual teacher, classroom, or class
period
Focused primarily on effective instruction to
enhance student growth
Focused primarily on disability determination
and documented through a checklist
A system to provide instructional intervention
immediately based on student need
A method for just increasing or decreasing
special education numbers
Key Components Problem-Solving Team Teams are composed of a variety of educational staff, including teachers, specialists, administrators, school psychologists,
and consultants. Team members should include individuals who have a diverse set of skills and expertise that can address
a variety of behavioral and academic needs.
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Problem-Solving Process The importance of assessment and effective instruction for RTI cannot be overstated. However, the problem-solving
model serves as the overarching structure which organizes assessment and intervention activities. Therefore, problem
solving lies at the heart of RTI. Problem solving means going beyond fulfilling procedural requirements and checklists to
doing what it takes to resolve students’ learning problems. The problem-solving model has been organized into a series of
cyclical steps.
Define Problem
Is there a discrepancy between current and expected performance?
Problem Analysis
Why is the problem occurring? Has the student received quality instruction in the target skill? What diagnostics do you have to support hypothesis?
Evaluate Results/Data
Ask “Did it work?”
Determine the next steps: change/modify interventions, return to lower tier, move to higher tier,
Develop Plan Set
goals for students Ask –
how much should student grow to close the gap? Define who, when, and how plan should be implemented. See BCPS Student Proficiency Plan
Implement Plan
Implement plan with rigor & fidelity; Decide who will do the progress monitoring; how long interventions should be implemented; collect data
=
Progress Monitoring Progress monitoring is a systematic method for tracking and comparing individual or group performance through data collection. A consistent monitoring plan is essential to determine the effectiveness of instructional programs and interventions. Progress toward meeting the student’s goals is measured by comparing expected and actual rates of
learning. Based on these measurements, teaching is adjusted as needed. Thus, the student’s achievement progression is
monitored while instructional techniques are adjusted to meet the individual student’s learning needs.
To understand progress monitoring, it is important to understand key terminology:
Benchmarks: Expected rates of growth or learning. Usually measured three times per year (Fall, Winter, Spring)
Baseline: The initial performance taken on a student is often the median score of three baseline data points. The
baseline serves as the reference point for all future data collection. Aim lines: Also referred to as the goal line, the aim line depicts the anticipated growth and offers a comparison
for the trend line. The aim line is typically shown as the expected rate of progress toward either the district goal or
a goal developed by the problem-solving team.
Trend line: Indicates the actual rate of improvement; provides insight into future performance (will he/she meet
the goal?).
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Curriculum Based Measurement CBM is designed to measure skill fluency in early reading literacy, oral reading, writing, and math computational skills.
These brief probes (typically administered in 1 to 3 minutes) are used to monitor both the student’s level of performance and his or her rate of performance growth related to age or grade-level expectations. CBM is a form of progress
monitoring and is not considered diagnostic in nature. CBM probes are administered and scored using standardized
methodology and are a valid and reliable method to develop district, school, or classroom level norms.
Pre, Post and Benchmark Assessments PCCSS administers pre, post and benchmark assessments (Test Gate) on standards, Lexile (SRI) and Math numeration
(STAR). These formative assessments are used to pre plan for instruction and assess student achievement after delivery
of instruction.
Data-Based Decisions The most important part of progress monitoring is not just collecting data; it is using the data to make sound instructional
decisions. Schools must look at the data regularly, implement decision-making rules, and use the data continuously to
inform instruction.
Within the tiered continuum of service delivery, decision rules are necessary for adding or removing tier level student
support as educators address their needs for intervention delivery and eligibility decisions. These decision rules must rely
on pertinent student assessment data and current promotion criteria. At each step of the process, good decision rules
ensure effective, equitable, and fair treatment for all students. The PCCSS have developed these specific guidelines for
data-based decisions:
Cut scores for determining risk status: To identify students who are at risk, each teacher, school and system
will use local comparative data from student performance on the pre, post and benchmarks from each grade level.
Typically this cut score is those scoring at or below the 25th
percentile. For the PCCSS system, each school will establish cut scores.
The frequency and duration of progress monitoring: During Tier 2 and Tier 3 service delivery, the frequency
and duration of progress monitoring will have an impact on whether sufficient data has been collected to
determine a student’s responsiveness to intervention. First, data must be collected with sufficient frequency to
detect changes in performance following instruction/intervention. It should be no less frequent than one time per
week at each Tier. Second, the length of the data collection period during intervention must be established. This
may be determined by the specific intervention being used (as outlined in the intervention manual). A minimum
of four weeks of intervention should be delivered. The length of time should allow for no fewer than six data
points during an intervention phase. As with any test, the more data gathered, the more reliable the decision will
be about whether a student is responding to an intervention. Students that are already receiving Gifted or ESOL
services should still follow the steps in the Tier process and should be provided interventions and progress
monitoring as needed. If the additional services are not yielding results then a meeting should be held which
includes the students gifted or ESOL teacher. As to the timeline, professional judgment is critical. Crisis
placements are available, but are to be used sparingly and should be based on solid information.
Criteria for determining a student’s responsiveness to intervention: Determination of whether students are responding to interventions requires specifying decision rules based on students’ levels and rates of progress, both
prior to and after the initiation of intervention delivery. This is established through trend line comparisons (or gap
analysis), which will be explained later.
Understanding Norms
Data can be used to compare student performance to the typical student in specific academic or behavioral skills.
Local Norms: Involves sampling the abilities of students at specific grade levels in a school or district.
National Norms: Involves sampling the abilities of students nationally, or based on research collected over time.
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Setting Ambitious and Realistic Goals As discussed earlier, an important part of a problem-solving process is setting goals or expected criteria for the students to
obtain. Setting goals that are realistic yet challenging is crucial to making good on-going decisions within a problem-
solving model.
Goal setting can be done at the group as well as at the individual level. For example, in an RTI model, it is expected that
the implementation of a high quality, scientific, research-based instructional program implemented with fidelity at Tier 1
should result in successful outcomes for at least 80% of all students (National Association of State Directors of Special
Education, 2005). When universal screening data find substantially fewer students successfully meeting benchmarks, the
indication is that changes are needed in the delivery of the core program (within Tier 1) to improve outcomes for all
students; this must be done before a determination could be made of the degree to which supplemental instructional
programs at Tier 2 are impacting outcome. As such, problem-solving teams may put in place goals that reflect a focus on
improving the school-based outcomes of student performance within the core program.
At the individual level, when students are identified through an RTI process as at-risk (and the core program is
implemented with fidelity), it is critical that goals be established for the individual student so that the outcomes of his or
her progress can be measured against appropriate expectations. By setting goals and monitoring a student’s progress
toward those goals, the impact of instruction can be assessed in an ongoing manner, and adjustments in instruction and
goals can be made as the instruction is proceeding. Keep in mind that the ultimate goal is to close the achievement gap
and meet the academic expectations established by PCCSS.
A key element of effective goal setting, whether used at the group or individual level, is the establishment of benchmarks
specifying the minimal expected performance for all students. The rate of improvement (ROI) or slope is a key indicator
that sets the criterion against which student performance will be compared. Closing the gap for those students whose
starting point is below benchmark would be a critical goal for teams to consider.
Steps for Setting Goals
1. Identify a starting point (or baseline) 2. Identify a goal or benchmark (target) / promotion criteria
3. Subtract current (baseline) level from target
4. Divide by number of weeks left until target 5. This will be your rate of improvement (ROI) to meet goal
6. Compare student’s ROI with a typical, or average, ROI for that student’s grade level. 7. Ask: Is this goal realistic? (With interventions, is this a goal that’s possible to attain?)
8. Ask: Is this goal ambitious? (With interventions, will this goal allow for the gap to close or will the student
simply not fall any further behind?)
9. If necessary, adjust the goal
Goals must be monitored and may be adjusted based on student progress.
End of Year Target – Current Score = Amount of growth to close gap
Amount of Growth = Weekly Target Number of weeks
Trend line or Gap Analysis Having a consistent decision-making rule is crucial to monitoring progress. There are many established ways to analyze
trend lines, including slope comparisons, the trend line rule (Tukey method), and the four-point rule. Comparing slopes of
the aim line and trend line is most accurate, followed closely by the trend line rule. However, both of these methods are
time consuming. The four-point rule is fairly simple to implement. It is easy for teachers to look at the data.
Trend line rule: Calculated by dividing the data points into three equivalent sections. The median scores from the
first section and last section are marked and connected by a line. This is the trend line.
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o When we compare that trend line to the goal line, if the trend line is steeper we want to raise the goal or
move the student back to the prior Tier
o If the trend line is consistently around the goal line, continue interventions. This may be an indicator that
the intervention is working but maintenance of the skill has not been established.
o If the trend line is decreasing or “flat-lined,” it is time to reevaluate or change interventions. Four-point rule: This rule is a quick but less accurate method of gap analysis, based on the 4 most recent
consecutive data points
o If the 4 data points are all ABOVE the goal line, keep the current intervention and increase the goal or
move the student to the prior Tier
o If the 4 data points are all BELOW the goal line, keep the current goal and modify the intervention o If the 4 data points are not consistently above or below the goal line, maintain the current goal and
intervention and continue collecting/reviewing data Each school’s problem-solving teams will be provided an excel spreadsheet which will chart and calculate aim lines and
trend lines for each student; the Gap Analysis goal for each area at each school will be the designated county standard
promotion criteria with intermediate/short term goals calculated and listed on the analysis form (See Appendix A PCCSS
Forms 2, 3, or 4).
Instruction & Intervention To increase the opportunity for success at all levels within the RTI framework, instruction and interventions delivered to students should be supported by evidence of their effectiveness. A clear distinction is made between instructional
strategies and interventions. A strategy is a tool, plan, or method used to guide and improve student learning. These
strategies are more commonly referred to as differentiated instructional tools and practices.
A research-based intervention is one that is school-based, prescriptive, and has a clear record of success. RTI requires
programs and interventions that have been validated in educational research. EIP and after school tutoring are not
scientific based interventions. EIP and after school tutoring is the place where interventions are implemented (i.e. Head
sprout lessons, Alphabetic Phonics, Guided Listening). These are interventions on which data collection is based. EIP and
after school are a PLACE to receive the intervention, just like the classroom. In essence, the following questions must be
asked:
• Has the study been published in a peer-reviewed journal or approved by a panel of independent evaluators?
• Have the results of the study been replicated by other scientists?
• Is there consensus in the research community that the study’s findings are supported by a critical mass of
additional studies?
Guidelines for Minimally Acceptable Interventions 1. Interventions are chosen based on classroom factors and reasonableness for the situation and severity of the problem. 2. Scientific evidence for the effectiveness of the interventions must exist.
3. Interventions are chosen based on students’ instructional needs (and not merely on availability or convenience). This
guideline means that individual student data justifies the choice of intervention(s).
4. A pre-specified, structured, and organized plan for each intervention session.
5. Interventions should increase in intensity (i.e., frequency, length of intervention sessions, change in intervention
strategies) in the event that a student does not make adequate progress as determined by the goal level established through
the problem solving process (according to the criteria described in the previous section on data-based decision making).
6. Unless a crisis situation or professional judgment dictates otherwise, there should be a minimum of 4 weeks of
intervention sessions (and 6 data points) before a determination of effectiveness is made, unless the guidelines of the
intervention specify otherwise.
7. Intervention sessions should be carried out as prescribed and there should be evidence that they were carried out as
planned. Evidence can include training, permanent products, and direct observation by an independent party. 8. There should be a minimum of two phases of intervention (based on decision criteria described in the previous section
on data-based decision making) before moving a student to Tier 3 or making a referral for a special education evaluation.
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Although evidence supporting an intervention’s effectiveness is important, the intervention itself is only as good as the
accuracy and consistency with which it is implemented. Fidelity refers to the degree to which interventions are
implemented as planned. It is essential that safeguards be put into place to determine if those interventions are being
carried out as they were intended. A student’s responsiveness to an intervention may eventually be used in special
education eligibility decision making. Therefore, school personnel must be confident that the intervention was performed
with high levels of fidelity. Regular monitoring of intervention delivery through observations and checklists is integral to
ensuring that the interventions continue to be implemented correctly and accurately (i.e., with “fidelity”) and that they
continue to benefit those whom they are intended to serve. Fidelity should be directly monitored by an independent
observer other than the interventionist; in Putnam County Schools this assignment is determined by the SST/Tier 3
Committee with input from a school administrator.
Instruction and Intervention Factors to Consider at all Tiers • Were the programs and interventions supported by scientific research?
• Were standard treatment protocols followed for the interventions with students? • Were the interventionists trained in delivering the intervention with fidelity?
• Were the interventions delivered for a sufficient amount of time?
• Was a team used to help design and support the intervention(s)?
Implementation of RTI The following guide may assist in implementing the RTI model with fidelity and enhancing consistency across the
district. Although instructional programs and pyramids of interventions may vary among schools, the key components of
the problem-solving process need to be included in each building.
Tier 1 The curriculum should be aligned with core content.
Research-based programs should be implemented with fidelity and rigor to address core instruction. Three times per year, all students are assessed using the district-wide assessment tool or district learning check.
This is considered progress monitoring at Tier 1.
Problem-solving must take place at the core if less than 80% of students are at benchmark, based on district
learning checks. Teachers are responsible for execution of the core program and differentiated instructional practices.
Teachers should be supported by grade-level and school based teams that discuss and analyze data and brainstorm
strategies that will address the needs of all learners.
Teachers and families should communicate about student progress in the curriculum.
Tier 2 Once students are identified as being at-risk, or falling below district benchmark, the problem-solving process is
initiated
Teachers may opt to include in the At-Risk “pool” students who met district benchmarks, if there is sufficient data to support this decision.
Teachers gather all relevant pieces of diagnostic and classroom data to reference during the problem-solving team
meeting.
The team works through the problem-solving process and determines if the student will require intervention to meet the next district benchmark
If yes, the school will develop a student proficiency plan (documented on PCCSS Form 1 Proficiency Plan &
Review) and parents are notified. Special factors to be considered include:
o Goal o Intervention
Method of delivery
Frequency
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15
Intensity
Duration Any adjustment in schedule?
What resources are available or what training may be needed?
o Progress monitoring tool & frequency (at least once per week) o Next review date?
Continue parent communication, informing them of the intervention and progress (PCCSS Form 5)
At each review of the progress monitoring data and the SPP, all data should be documented on A gap analysis
must be completed at least monthly to determine if the goal is being me (PCCSS Form 2, 3, 23, or 4 for pre-k).
o If goal is being met: Raise the goal but continue the intervention? Stop the intervention and move student back to Tier 1? It is perfectly acceptable to continue with Tier 2 services for a prolonged period of time if that is
what the student needs. For most students the team will want to think about how they can get a
student ready for Tier 1 without the Tier 2 services over time (scaffold away the support).
However, there may be a handful of students who will need Tier 2 for a prolonged period.
o If goal is not being met: Review problem-solving process Change interventions? Increase frequency of intervention?
Increase intensity of intervention?
If this intervention is the second intervention attempted, the team may consider whether moving
the student to Tier 3 is appropriate.
Tier 3 If a student moves to Tier 3, the problem-solving process is executed identical to Tier 2, although the intervention
and progress monitoring may increase in intensity and frequency.
As with Tier 2, it is imperative to review progress monitoring data to make decisions about student progress.
A gap analysis should be completed at least every two weeks. (PCCSS Form 2, 3, 23, or 4 for pre-k).
o If the goal is being met: Raise the goal but continue the intervention? Decrease the intervention and move student back to Tier 2 or Tier 1?
o If the goal is not being met: Review problem-solving process Change interventions?
Increase frequency of intervention? Increase intensity of intervention?
If this intervention is the second intervention attempted, the team may consider a special
education referral for a comprehensive evaluation (see Checklist Forms PCCSS 13 or 14) Procedures in the event RTI guidelines as outlined in this manual are not followed:
1. Upon referral from Tier 2, the RTI coordinator will review all intervention data
a. Accept the referral and set up a Tier 3 review
b. Return the referral and provide professional development in the deficient area(s)
c. If problems persist following professional development, the RTI Coordinator will request
consultation with building administrator who will provide written documentation of deficiencies
along with a corrective action plan.
2. Upon referral from Tier 3, the School Psychologist will review all intervention data
d. Accept the referral and arrange for a full evaluation
e. Return the referral and provide professional development in the deficient area(s)
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f. If problems persist following professional development, the School Psychologist will request
consultation with the building administrator who will provide written documentation of
deficiencies along with a corrective action plan.
The ultimate responsibility for the RTI process lies with the building level principal. Principals should monitor
instructional staff for areas in which too few or too many referrals are being made.
Tier 4 An Individual Education Plan (IEP) will be developed for the student.
It should be noted that some students may always require Tier 2 or Tier 3 interventions to be successful in the core
program and meet expected benchmarks. These students are not otherwise identified as receiving special education
services, given that special education is reserved for those who have identified disabilities.
Special Considerations in RTI Gifted & Talented -A tiered model of programming is a historical framework for the field of gifted and talented
education. Students who are gifted require special provisions because of their strengths and above-grade instructional
level or potential. Given that RTI supports setting targets or trend lines for individual students, long term planning and
monitoring of student progress allows students to learn and grow toward accelerated expectations.
Students with Individual Education Plans - Because RTI encompasses all students, students with IEP’s
should always be considered to be part of the four-tiered model. It is imperative to include special education staff in the
problem-solving process in order to review student eligibility, individual goals and objectives, and
accommodations/modifications on the IEP. Please reference Appendix C for a flowchart when a student with an IEP is
identified as At-Risk on the district benchmark.
ESOL Students – – Upon enrollment, any child whose enrollment form lists a language other than English,
is scheduled for a language screener & consideration for ESOL. The Wide Access Placement Test is given to
determine language proficiency. EL students are also considered part of the four-tiered model. Although students are
receiving ESOL services or may be monitored by the district for two years after exiting, if not successful they still need
additional consideration through the tiers. The ESOL teacher should be an integral part of the meeting process and should
provide strengths and weaknesses for the EL students. Documentation of differentiated instruction for EL should be noted
in teacher lesson plans.
Referral for Individual Evaluation for Special Education Services - For students who do not make
adequate progress on their Proficiency Review Plans (PRP), the problem-solving team may consider a referral for an
evaluation for special education services. The data collected in the RTI process shall be considered by the Department of
Special Programs and Exceptional Students as part of the referral process. Refer to referral procedures for special education for more information.
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KEY TERMS & ACRONYMS College and Career Ready Performance Index: A statewide accountability system mandated by the ESEA of 2001
which requires each state to ensure that all schools and districts make Adequate Yearly Progress as defined by states and
approved by the US Department of Education
Aim line: Line on a graph that represents expected student growth over time; goal line.
Benchmark assessments: Short assessments given at the beginning, middle, and end of the year to establish baseline
achievement data and progress
Charting: A visual depiction of the student’s performance data, relative to the baseline and aim line which includes
baseline data, aim line, progress monitoring data, and trend lines (see GAP Analysis PCCSS Forms 2, 3, 4, or 23).
Core principles of RTI necessary for RTI processes to be effective:
All students can learn
Early intervention for struggling learners is essential
Use of a multi-tier model of delivery is necessary
Utilization of a problem-solving methodology
Curriculum-Based Assessment (CBA): Measurement that uses direct observation and recording of a student’s
performance in the local curriculum as a basis for gathering information to make instructional decisions
Curriculum-Based Measurement (CBM): CBM is a method for monitoring student progress through a curriculum. It
reflects the success of students’ instructional program by using short, formative assessments that are normed.
Data-based decision making: A process in which school personnel engage in ongoing analysis of data from multi-level
sources to provide a comprehensive picture of strengths and challenges and develop a plan to prioritize and address those
challenges.
Data points: Points on a graph that represent student achievement or behavior relative to a specific assessment at a
specific time
Dimensions of reading: The five research based dimensions of reading as outlined in the Elementary and Secondary
Education Act of 2001 (NCLB)
Phonemic Awareness
Phonics
Fluency
Vocabulary
Comprehension
Differentiated instruction: Process of designing lesson plans that meet the needs of the range of learners. Such planning
includes learning objectives, grouping practices, teaching methods, varied assignments, and varied materials chosen based
on student skill levels, interest levels, and learning preferences. Differentiated instruction focuses on instructional
strategies, instructional groupings, and an array of materials.
Discrepancy: Difference between two outcome measures
IQ-Achievement discrepancy – difference between scores on a norm-referenced
i.e. intelligence test and a norm-referenced achievement test
Difference between pre-test and post-test on a criterion-referenced test
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Dual discrepancy: A dual discrepancy occurs when a student’s performance and growth rate are both substantially below
performance and growth rate of typical peers
Duration: The length of time over which a student receives an intervention (e.g., 15 weeks)
Essential components of an RTI process: Core components of an effective RTI process
School-wide screening
Progress monitoring
Tiered services
Fidelity of implementation
ESOL: The services provided to students identified as English Learner’s. Students are served in either a pull out or push
in model served by an ESOL certified teacher.
Evidence-based practice: Educational practices/instructional strategies supported by relevant scientific research studies
Fidelity of treatment: Implementing a program, system or intervention exactly as designed so that it is aligned with
research and ensures the largest possible positive outcome
Formative assessment/evaluation: Classroom/curriculum measures of student progress; monitors progress made
towards achieving learning outcomes; informs instructional decision making
Frequency: The number of times a student receives an intervention in a given timeframe (e.g., daily, twice weekly)
General Outcome Measure: A quick and reliable indicator of academic performance in such areas as reading, math, and
written expression
Goal: Standard against which progress can be compared and allows for an aim line to be established. Possible goals
could be established based on the following: • Norms • Percentile cutoff
• Growth rates • Local growth rates
Goal Line: See Aim line
Graph: Provides a visual representation of a large amount of data
Growth rate: Gives you a growth expectancy for each week of school year; Allows for obtaining student’s baseline then
monitoring progress while comparing to growth expectancy
ICEL: Instruction, Curriculum, Environment, Learner (domains of influence in problem-solving)
IDEA - Individuals with Disabilities Education Improvement Act of 2004; Original passage in 1975; latest reauthorization
in 2004; federal statute relative to public education and services to students with disabilities ages
3 through 21
Intensity: The length of time during which a student receives an intervention (e.g., 30 minutes)
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19
Intensive interventions: Academic and/or behavioral interventions characterized by increased length, frequency, and
duration of implementation for students who struggle significantly; often associated with narrowest tier of an RTI tiered
model; also referred to as tertiary interventions/TIER 3.
Interventions: Instructional strategies and curricular components designed to improve or remediate a certain set of skills
Key practices in RTI: Practices necessary for RTI processes to be effective
Using research-based, scientifically validated instruction and interventions
Monitoring of student progress to inform instruction
Making decisions based on data
Using assessments for universal screening, progress monitoring, and diagnostics
LEA: Local Education Agency: Refers to a specific school district or a group of school districts in a cooperative or
regional configuration
Learning Checks: See Universal screening
Learning Disability/Specific Learning Disability (SLD) [from federal regulation §300.309(a)(1)]: The student does not
achieve adequately for the student’s age or to meet State approved grade-level standards in one or more of the following
areas, when provided with learning experiences and instruction appropriate for the student’s age or State-approved grade
level standards:
(i) Oral expression.
(ii) Listening comprehension.
(iii) Written expression.
(iv) Basic reading skills.
(v) Reading fluency skills.
(vi) Reading comprehension. (vii) Mathematics calculation. (viii) Mathematics problem solving (math reasoning)
Learning rate: Average progress over a period of time, i.e. one year’s growth in one year’s time
Mean: The average of a data distribution; (the sum of scores divided by the number of scores)
Median: The middle score in a data distribution.
NCLB/ESEA – No Student Left Behind/Elementary and Secondary Education Act
Normative scores: Scores that provide information about how a student performed relative to some comparison group
(classroom, school, district, state, or national)
ORF: Oral Reading Fluency; words read correctly in one minute
Percentile rank: A number assigned to a score that indicates the percentage of scores found below that score.
Primary levels of intervention: Interventions that are preventive and proactive; implementation is school-wide or by
whole-classroom; often connected to broadest tier (core or foundational tier) of a tiered intervention model/TIER 1.
Problem-solving model (PSM): Solutions to instructional and behavioral problems are addressed by going through a
four-step process: (problem identification, problem analysis, plan implementation, and plan evaluation); is sensitive to
individual student differences; depends on the fidelity of implementing interventions
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Problem-solving team: Group of teachers and school staff who meet regularly to help design interventions for and
monitor progress of students who are at-risk for failure
Progress monitoring: Data used to frequently check student progress towards success; Progress monitoring is a
scientifically based practice that is used to frequently assess students’ academic performance and evaluate the
effectiveness of instruction. Progress monitoring procedures can be used with individual students or an entire class.
Quartile: One-fourth of a distribution of scores
Remediation: Instruction intended to remedy a situation; to teach a student something that he or she should have
previously learned or be able to demonstrate; assumes appropriate strategies matched to student learning have been used
previously
Response to Intervention / Response to Instruction / Responsiveness to Intervention (RTI): Practice of providing high
quality instruction and interventions matched to student need, monitoring progress frequently to make changes in
instruction or goals and applying student response data to important educational decisions
RIOT: Review, Interview, Observe, and Test; Information collected as part of the RTI problem-solving process, in order
to develop an intervention
Scientifically-based/Research-based interventions: Instructional strategies and curricular components used to enhance
student learning. The effectiveness of these interventions is backed by experimental design studies that
Use empirical methods
Include rigorous and adequate data analysis
Have been applied to a large study sample
Are replicable
Show a direct correlation between the interventions and student progress, and
Have been reported in a peer-reviewed journal
Scientific/Research-based instruction: Curriculum and educational interventions that have been proven to be effective
for most students based on scientific study
Screening – See Universal screening
SEA: State Education Agency, refers to the department of education at the state level
Slope: Rate of growth or improvement in performance over time
Specific Learning Disability: See Learning Disability
Standard protocol intervention: Use of same empirically validated intervention for all students with similar academic or
behavioral needs; facilitates quality control
Strategic interventions: Intervention chosen in relation to student data and from among those that have been documented
through educational research to be effective with like students under like circumstances; often associated with second tier
of an RTI tiered model; also referred to as secondary interventions/TIER 2.
Summative assessment/evaluation: Comprehensive in nature, provides accountability and is used to check the level of
learning at the end of a unit of study. Systematic data collection: Planning a timeframe for and following through with
appropriate assessments to set baselines and monitor student progress
TIER 1, TIER 2, TIER 3: See Primary Levels of Intervention, Strategic Levels of Intervention, Intensive Interventions
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Tiered instruction: Levels of instructional intensity within a tiered model
Tiered model: Common model of three or more tiers that delineate levels of instructional interventions, based on student
skill need
Trend line: Line on a graph that connects data points; compare against aim line to determine responsiveness to
intervention
Learning Focused: Learning-Focused is a comprehensive continuous school improvement model that: provides schools
with consistent learning, provides exemplary strategies instruction and integrates research-based exemplary practices.
Universal screening: A process of reviewing student performance through formal and/or informal assessment measures to
determine progress in relation to student benchmarks; related directly to student learning standards. Those students whose
test scores fall below a certain cut-off are identified as needing more specialized academic interventions. Universal
screening usually takes place three times/year (Fall, Winter, Spring)
Validated intervention: Intervention supported by education research to be effective with identified needs of sets of
students
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Reading RTI - Primary School Model (each school modifies to fit developmental levels)
TIER 3
Intensive, Individualized Interventions Targeted
Instruction based on SPECIFIC needs (problem
solving approach)
EIP Responsible (groups 1-3) Interventions determined by SST committee
TEACHERS
WILL…
- Fill out SPP
- Conduct
intervention
- Progress
monitor (via
DIBELS)
- Complete
SPP Review
- Get fidelity
check
If above steps
completed
and
intervention
unsuccessful,
refer to EIP
via EIP entry
form
TIER 2
Targeted Group Interventions
Targeted Instruction based on AREA of need (standard protocol approach)
Teachers
must try
one
intervention
and
progress
monitor in
the
classroom
before EIP
is an
option.
Fidelity
checks will
be
completed
by a Tier 3
committee
member
before EIP
is
considered.
Intervention #1: Teacher Responsible
(2-3 days a week)
Basic Reading Skills – (phonological
awareness, phonics)
Lexia
Headsprout (ESOL/SPED)
Fluency – w/ trained student/volunteer
Assisted Reading Practice
Listening Passage Preview
Paired Readings
Repeated Readings
Timed Readings
Comprehension – Story Maps
Comprehension Cards
Intervention #2: EIP Responsible
(groups of 6-8, 5 days a week)
PALS
Tyner
Read Well (2nd
grade, if needed)
FCRR
U. of Mississippi Interventions
Road to the Code
I’ve DIBELed Now What?
*Fidelity check completed during administration
observation
If intervention #2 is unsuccessful,
refer to Tier 3. You will need:
SPP/SPP Reviews, Progress Monitoring
(DIBELS graphs/gap analysis), Student History,
Parent Communication, Work Samples,
Vision/Hearing Screening, Report Card, Request
for Tier 3 meeting
TIER 1 Core Instruction - What all teachers are expected to do
Standards-based instruction Research Based Strategies (including: direct and
Small group instruction explicit instruction, fast paced lessons, corrective
Re-teaching feedback, modeling, multiple practice opportunities,
Remediation/Enrichment scaffolding, review, clear procedures/lesson structure, Acceleration etc.)
Differentiated instruction Learning Focused Strategies (including:
Flashcards / Extra practice activating strategies, assessment prompts,
Informal tutoring with untrained parent/peer collaborative pairs, essential questions, graphic
Homework (including extra/individualized homework) organizers, differentiated assignments, vocabulary
instruction, summarizing strategies, etc.)
*** Tier 1 issues are generally related to isolated skills, rather than groups of skills. When students are missing a few skills, it can
generally be solved at Tier 1. When the whole class is missing a skill, this is also a Tier 1 issue. Math RTI - Primary Model (each school modifies for developmental levels)
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TIER 3
Intensive, Individualized Interventions
Targeted Instruction based on SPECIFIC needs
(problem solving approach)
EIP Responsible (groups 1-3); Interventions determined by SST committee.
TEACHERS
WILL…
- Fill out SPP
- Conduct
intervention
- Progress monitor (via
DIBELS)
- Complete SPP Review
- Get fidelity
check
If above steps
completed
and
intervention
unsuccessful,
refer to EIP
via EIP entry
form
TIER 2
Targeted Group Interventions Targeted
Instruction based on AREA of need (standard
protocol approach)
Teachers
must try
one
intervention
and
progress monitor in
the
classroom
before EIP
is an
option.
Fidelity
checks will
be
completed
by a Tier 3
committee
member
before EIP
is
considered.
Intervention #1: Teacher Responsible
(2-3 days a week)
Number Sense-
Great Number Line Race
Strategic Number Counting
Instruction
Number Race (computer)
Number Catcher (computer)
Math Facts-
Cover, Copy, Compare
Incremental Rehearsal
Constant Time Delay
Easy/Hard Problems interspersed
Problem Solving-
Self-Monitoring
Self-Correction
Graphs-
Question-Answer-Relationships
(QAR’s)
Intervention #2: EIP Responsible
(groups of 6-8, 5 days a week)
PALS
Meta-cognitive Strategies
Strategic Math Series (available for
purchase, cheap but good!)
http://www.kucrl.org/sim/strategies/math.sh tml
*Fidelity check completed during
administration observation
If intervention #2 is unsuccessful,
refer to Tier 3. You will need: SPP/SPP Reviews, Progress Monitoring
(DIBELS graph/Gap Analysis), Student
History, Parent Communication, Work
Samples, Vision/Hearing Screening,
Report Card, Request for Tier 3 meeting
TIER 1 Core Instruction - What all teachers are expected to do
Standards-based instruction *Research Based Strategies (including: direct and Small group instruction explicit instruction, fast paced lessons, Re-teaching corrective feedback, modeling, multiple practice Remediation/Enrichment
opportunities, scaffolding, review, clear Acceleration
procedures/lesson structure, etc.) Differentiated instruction
Flashcards / Extra practice *Learning Focused Strategies (including:
Informal tutoring with untrained parent/peer activating strategies, assessment prompts,
Homework (including extra/individualized homework) collaborative pairs, essential questions, graphic organizers, differentiated assignments, vocabulary instruction, summarizing strategies,
etc.)
*** Tier 1 issues are generally related to isolated skills, rather than groups of skills. When students are missing a few
skills, it can generally be solved at Tier 1. When the whole class is missing a skill, this is also a Tier 1 issue.
Behavior RTI - Primary Model (each school modifies for developmental levels)
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TIER 3*
Intensive, Individualized Interventions
Targeted Interventions based on SPECIFIC needs
(problem solving approach)
Interventions determined by SST committee
TIER 2*
Targeted Group Interventions Targeted
Instruction based on AREA of need (standard
protocol approach)
ABE tutorials
HUG club
Check and Connect (SPED)
Behavior Contract
Mystery Motivator
Points for Grumpy
Attention Seeking –
Non-contingent Reinforcement (Random teacher attention)
http://www.interventioncentral.org/behavioral-interventions/challenging-students/school-
wide-strategies-managing-defiance-non-complianc
Motivation – http://www.interventioncentral.org/behavioral-interventions/motivation On-Task –
Rubber Band Intervention
Self-monitoring
http://www.interventioncentral.org/behavioral-interventions/challenging-students/school-
wide-strategies-managing-task-inattention
Hyperactivity –
Self-monitoring
http://www.interventioncentral.org/behavioral-interventions/challenging-students/school-
wide-strategies-managing-hyperactivity
TIER 1*
Core Instruction - What all teachers are expected to do http://www.interventioncentral.org/behavioral-interventions/challenging-students/teacher-behavioral-strategies-menu
Positive Behavioral Interventions and Support (PBIS)
“Behavior Barometer”
Skillstreaming
Bucketfillers
Character Cards
Class-wide and Individual Incentives/Rewards
*Tiers depends on response to intervention AND severity of behavior (i.e. danger to self or others).
Page 1 of 2
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25
STUDENT PROFICIENCY PLAN/PROGRESS MONITORING Date of initial plan:
Student: DOB
Grade level:
School: Head Start/PCPS/PCES/PCMS/PCHS / Private School
Referring Teacher:
/ EIP Teacher:
Area of Concern: reading fluency/basic reading/reading comprehension/basic math/math reasoning/
listening comprehension/oral expression/behavior/other
Baseline Data (quantitative):
Promotion Criteria (na if behavior):
Growth needed per quarter to meet promotion criteria(na if behavior):
Staff responsible for progress monitoring:
Fidelity Checklist to be monitored by: Tier 2 or 3 Team Member
Next review date: Other Discussion Items:
FIDELITY CHECK includes:
intervention program is based on research standard treatment protocols are followed staff are trained as needed intervention is delivered for a sufficient period of time decision are made by a team
List all team members included in Tier 2 decision making:
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26
DO NOT SUBMIT for referral unless this form is complete; PROGRESS MONITORING COLUMN MUST
HAVE QUANTITATIVE DATA with minimum of 4 data points Intervention # 1 Dates Progress Monitoring
Data Progress sufficient to meet
promotion criteria/Decision:
(reference)
Adequate progress: yes/no Fidelity check completed by: Review: Decision: continue; modify;
New intervention; refer; end
Intervention # 2 Dates Progress Monitoring
Data Progress sufficient to meet
promotion criteria/Decision: (reference)
Adequate progress: yes/no Fidelity check completed by: Review: Decision: continue; modify;
New intervention; refer; end
Intervention # 3 Dates Progress Monitoring
Data Progress sufficient to meet
promotion criteria/Decision: (reference)
Adequate progress: yes/no Fidelity check completed by: Review: Decision: continue; modify;
New intervention; refer; end
Intervention # 4 Dates Progress Monitoring Progress sufficient to meet
promotion criteria/Decision:
(reference)
Adequate progress: yes/no Fidelity check completed by: Review: Decision: continue; modify;
New intervention; refer; end
PCSS Form 1 SPP and Progress Monitoring / last update July 2014
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RTI GAP Analysis
School: Student: Teacher: EIP: Grade: Tier: Area of Concern: Monitoring Tool:
Date Score Goal Intervention
Form Last updated July 2014
14 15 PCCSS Form 2 GAP Analysis
Page 27
28
8/29/2014 150
9/6/2014 200
9/13/2014 220
9/20/2014 205
8/2
9/2
014
8/3
0/2
014
8/3
1/2
014
9/1
/20
14
9/2
/20
14
9/3
/20
14
9/4
/20
14
9/5
/20
14
9/6
/20
14
9/7
/20
14
9/8
/20
14
9/9
/20
14
9/1
0/2
014
9/1
1/2
014
9/1
2/2
014
9/1
3/2
014
9/1
4/2
014
9/1
5/2
014
9/1
6/2
014
9/1
7/2
014
9/1
8/2
014
9/1
9/2
014
9/2
0/2
014
RTI GAP Analysis SAMPLE Monitoring School: Student: Teacher: EIP: Grade: Tier: Area of Concern: Tool:
PCES Sample Perfect Cheal 3 2 comprehension SRI
Date Score Goal Intervention
CARS/STARS
500
Sample: progress monitoring
for reading comprehension
Score Goal
500
150 200 220 205
Form Last updated July 2014
14 15 PCCSS Form 2 GAP Analysis
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29
Putnam County Schools
TIER 2 Head Start - Pre-K - K (Children <7 years) Tracking Sheet
Student Name:
AGE:
Sex: M / F Race: W / B /H / O Referring Teacher:
Dates Intervention:
(what are you
going to do for
this student IN
ADDITION to
what you are
doing for the
others?)
Z Y X W V U
T S
R Q P
O N M L K J I H G
F E D C B A
Data Analysis: IDENTIFYING CAPITAL LETTERS
Evaluation of Intervention (IS IT WORKING?) yes, continue yes, modify
no, discontinue
Peer Comparison: (how are most of the other students doing?)
Other Teacher Comments:
PCCSS Form 4
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Putnam County Schools
DOCUMENTATION OF PARENTAL CONTACT
(Recommended form: submit only the # of parent contacts & attempted parent contacts)
Student Name: Grade: Teacher:
Parent with whom contact was made:
Contact Information: Phone number(s)
[NOTE: also document ATTEMPTED contacts]
Contact #1 phone letter face to face other Contact Date:
Contact Summary:
Contact #2 phone letter face to face other
Contact Date:
Contact Summary:
Contact #3 phone letter face to face other
Contact Date:
Contact Summary:
Contact #4 phone letter face to face other
Contact Date:
Contact Summary:
PCCSS Form 5
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Administrative Data
For School Year
Student Legal Name:
Student called name:
Date of Birth:
Grade Level:
Primary Home Language: Race:
Gender: male female
Custodial Parent:
Address:
Home Phone: Cell Phone:
Parent E-mail:
Staff Contact:
PCCSS Form 10 Administrative Data (private school use)
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32
Putnam County Schools Observation Form
Page 1 of 2
(section 1 may be completed as part of Tier 2 or Tier 3 process; sections 2 & 3 must be completed AFTER parent
permission for evaluation)
Referral for evaluation requires ALL THREE SECTIONS
Teacher Grade Level Date of observation:
Staff completing this form: Subject being taught: Time:
Section 1. Structured Observation of Teacher/Classroom
Classroom
Environment
Pleasant Over stimulating neutral dull
Additional notes regarding environment:
Materials available age appropriate out of reach
Student
Engagement
high low none
Additional notes regarding student engagement:
Numbers # of adults (Do not include observer) # of students
Rules Posted Positively Stated Short/Clear Not visible
Adult Interactions Alpha (positive) i.e. please, thank you, good job, smile
Beta (negative) i.e. no, don’t, stop, quit
Section 2. Structured Observation of Student
Staff completing this form: Date of parent permission: Date of observation:
Subject being taught: Teacher(s) conducting the class: Time:
[NOTE: observations MAY NOT be completed by the teacher currently working with the student / for referral purposes
observation of the student MUST BE completed AFTER parental consent for evaluation AND in the area of suspected
disability)]
Placement of the child is conducive to learning (i.e. student can see & hear; can be seen & heard by the teacher) Yes No
Peer Interactions: positive neutral/withdrawn not observed / other notes:
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negative / verbal aggression negative/ physical aggression
Communications: clear not clear not observed / other notes:
Independence: self directed required assistance / other notes:
Activity Level: within normal limits overactive under active (lethargic) / other notes:
Affect: appears to be a happy child sad, withdrawn / other notes:
SECTION 3: Observer Notes:
Child was observed to have difficulty with:
starting tasks
staying on task
completing tasks
making transitions
interacting with others
producing work consistently organizing multi-step tasks
Task observed (at chosen intervals for up to 5 minutes, tally for on or off
task; then chose another student and do the same) DO THIS
SECTION ONLY WHEN APPLICABLE TO
STUDENT DIFFICULTY
Target child
:10 :20
:30
:40
:50
:60 :10
:20
:30 :40
:50 :60
:10
:20 :30
:40 :50
:60
:10 :20
:30 :40
:50 :60
:10
:20 :30
:40 :50
:60
Target Student: % time on task
% time off task
Peer
Peer:
% time on task
% time off task
PCCSS Form 7
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Student: Grade: Teacher: DATE of classroom work:
(Submit a work sample ONLY for the area of suspected or defined disability; complete a separate form for each
subject area to be addressed) (NOTE: progress monitoring (i.e. DIBELS or post tests) are NOT work samples –
this should be a sample of daily classroom work)
Subject area of work sample:
basic reading reading comprehension reading fluency written expression
basic math math reasoning oral expression listening comprehension
I. Assignment Description: What was the CONCEPT being taught or object of the lesson?
Time allowed for this assignment:
Assignment completion by: small group whole group homework
independent other:
Instructions were given: orally modeled (examples) written (visual)
other:
Assignment was: grade level not grade level (explain)
II. Assignment Completion:
Modifications (anything different from assistance given to the general class)? no yes,
Was behavior an interference factor? no yes, if yes, check any that apply:
apathetic, unmotivated discouraged frustrated distracted
required constant assistance out of seat off task yelling/blurting out
talking to others bothering others
other issues:
Other interference factors: skill yes no time yes no
III. Analysis: Assignment was completed: yes no, if not: how much (25%, 50%, etc) Grade rec’d
Time required for complete:
Completed as assigned: yes no, explain:
Peer Comparison (VITAL INFORMATION – BE SURE TO COMPLETE THIS SECTION:
Most other students completed the assignment as directed OR Other students had difficulty with this
assignment Peer general average on this assignment Additional Comments:
PCCSS Form 8
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Putnam County Schools Student Support Team Meeting Summary
(may be pasted into SEMS meeting summary page as a template)
Meeting Date: Student: Grade: School:
Referring Teacher:
EIP Teacher:
Meeting Date:
Meeting Purpose: Tier 2 or Tier 3 (SST)
Review of previous meeting notes/SST Member assignments:
Areas of Concern/Discussion Points:
Standard assessments:
Teacher input:
Baseline:
Interventions:
Progress Monitoring Data for each intervention:
Recommendations:
Next Meeting Date:
Determination: end interventions modify interventions
decrease interventions increase interventions
Attach signature sheet for all those in attendance
PCSS Form 9 SST Meeting Summary Template
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Meeting Summary
Meeting Coordinator:
Meeting Date:
Meeting Purpose: Tier 2 or Tier 3 (SST)
Student Name: Areas of Concern/Discussion Points:
Recommendations:
Next Meeting Date:
Determination: end interventions modify interventions
decrease interventions increase interventions
Attach signature sheet for all those in attendance
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X
Private School Referral for Psycho-Educational Evaluation
for the purpose of considering eligibility for special education
1. STUDENT INFORMATION
Student’s Name:
School District:
School:
Grade:
Putnam County
Primary Language at home: English Spanish Other
Birth Date:
Parent Permission to evaluate: Date:
Extenuating circumstances: _YES _NO
2. HISTORY
Reason the child was referred for special education evaluation or re- evaluation (check all that apply):
Academic: reading math language
Behavior: acting out withdrawal inattentive
Speech: articulation expressive listening
Parent request
Has the child attended (or is the child attending) a preschool or Head Start program?
_YES _NO
regular Head Start _regular Pre-K
Community / private day care or pre k program
Head Start or pre-k inclusion program.
Is this child age appropriate for grade level?
_YES _NO
If no, please check all of the following that apply:
Retained: (Specify Grade):
Started School Late:
Held Out of School by Parents:
Is the child’s hearing/vision within normal limits (attach documentation)?
_YES _NO
Attach documentation or explain.
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38
Does the child have significant health concerns, major childhood illness/disease, or a diagnosed syndrome (i.e. ADHD)?
_YES _NO
If yes, please request physician verification (may be documented on PCSS Form 20):
Does the child take medication on a regular basis?
_YES _NO
If yes, are medications administered:
at home or by school nurse?
Please list medications:
Does the child have motor /coordination/mobility needs?
_YES _NO
If yes, please explain:
Does the child have adaptive or medical needs (e.g., eye glasses, wheelchair, walker, hearing aids, leg braces, feeding tube, etc.)?
_YES _NO
If yes, please explain:
Does the child have other significant issues not covered in the previous questions (attendance or discipline issues)?
_YES _NO
If yes, please explain:
Discipline issues:
Attendance issues:
Circumstances require immediate consideration of special education eligibility.
_YES _NO
Please explain:
3. RESULTS OF RELEVANT DISTRICT, STATE AND BENCHMARK ASSESSMENTS
Date: Name of Statewide, Local, or any Benchmark Assessments
You may list data here OR ATTACH computer printouts
Results:
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39
4. Include Proficiency Plan(s) and Progress Monitoring Data and Gap Analysis (PCSS Forms 1 and 2)
5. Staff Signatures
Role Staff Date
Staff initiating the referral:
Academic Coach:
School Principal:
Special Education Director:
PCCSS Form 11
Page 39
Page 1 of 2
40
Form: Child History (Parent Report) Date Completed:
Child’s Name: Child’s Date of Birth: Predominant Race:
Language spoken at home: English Language Proficiency:
very good okay poor
Phone where parent/guardian can be reached: Other emergency contact:
Parent/Guardian name: Child is Adopted: yes: if yes, child’s age: no
Current Address: Parent with whom child resides for most of the school year: father mother other
How often child sees non-custodial parent:
Email:
Family history of: learning problems attention deficit behavior problems
psychiatric problems chronic medical issues speech problems
If yes to any of the above, describe/explain:
Current Family Makeup (persons currently living at home with this child):
Family member: Relationship to
student
Family member: Relationship to
student
1. 4.
2. 5.
3. 6.
Birth History: Complications during pregnancy yes no / Full term yes no
Birth Weight: Complications in early infancy yes no
Developmental milestones on time yes no
Has your child had any of the following? CIRCLE ALL
that apply: Serious accidents/injuries
Head injury with hospitalization
Persistent high fevers:
Operations/surgeries:
Chronic Ear infections:
Emotional trauma:
Problems with vision/hearing
ADHD diagnosis:
Bi-Polar diagnosis:
Hospitalized in the last 12 months
Psychiatric treatment If
yes, where: Psychological
evaluations:
If yes, date:
Pre-K yes no / Head Start yes no
Has your child been retained (held back)?
yes no if yes, what grade:
List Current Medications:
No medications:
If yes to any of the above, please give more detail (where, when, etc)
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41
Community Agencies working with this child: DJJ DFACS Mental Health Agency
Schools my child has attended:
Strengths -- My child is good at: Weaknesses --Things that are difficult for my child:
is mostly happy
Mark any of the following that apply to this child:
has attempted self harm
is hard to control
shows concern for others
bites nails
gets along well with
others
helps with household chores
is usually pleasant &
cooperative
daydreams often does not adjust to change
is frustrated
talks of self harm
poor self control
is aggressive
is dependent
shows jealousy
sucks thumb wets bed
is uncooperative
is controlling
learns slowly is over active
has very few friends
lies
is often fearful
has a short attention span
is shy/withdrawn
acts immature
lacks motivation, lazy
destroys others’ things restless
is cruel to animals
is angry
worries a lot
demands attention
is anxious
is loud
cries a lot
hurts others (verbally) hurts others (physically) cannot get along
Cultural Expectations (list any that apply): i.e. children are expected to make eye contact
children are expected to remain quiet
children are expected to
Child’s sleep habits are: within normal limits
has difficulty sleeping
sleeps too much
sleeps too little
Study Habits (if applicable), my child:
Brings homework/agenda home yes no
Does homework without argument yes no
Organizes work to return to school yes no
Home Schedule, our family:
has meals together yes no
has a regular Bedtime yes no
has regular family fun yes no
Discipline at home: Home rules are established yes no // Child generally obeys rules yes no
Who administers discipline? mother father other Child’s response to discipline?
Does your child have any specific limitations or needs that the school should know about at this time? yes no if yes,
(please use the back of this page for adding comments/concerns) Parent Concerns/Comments/Questions (use reverse side if needed):
Significant Family Events: (i.e. recent death in the family; mobility; family break up)
Comparison to siblings/close cousins (i.e. child is doing better than/worse than/or about the same as
siblings when they were his age):
Signature of Person Completing this form:
Date:
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INITIAL EVALUATION PACKET CHECKLIST (Green Sheet – A Form 13)
HEAD START / PRE-K or K Programs (children under 7 years of age) Directions: 1. Items 1 to 3 must be completed prior to submitting the evaluation request to the
Central Office
2. After the testing is completed and the eligibility team/IEP Team has met, the completed checklist should
be submitted to the Central Office to document the 60 day timeline allowed under SDE Special Education
Program Guideline. Time Line Begins Time Line Ends (completed by Central Office)
Student Name:
Staff Submitting Checklist: (PRINT NAME)
Head Start Pre K Kindergarten
arrange needed forms in the order requested
DATE: Event & Staff Initials:
1. Referring Teacher Responsibilities: obtain parent permission for Vision/Hearing Screen Form 30
submit V/H form to Ms. Moreland OR request parents bring
in privately obtained current V/H screening
Form 4 tracking sheets for identified areas of concern
Meeting summaries with attendance sheets Form 10 student history (Form 12)
with less than adequate progress in 4 to 8 weeks; inform RTI Coordinator (with crisis
situation or professional judgment related to developmental delay this time line may be reduced)
provide any available assessment data maintain & continue parent communication log Form 5
obtain adaptive rating scales from School Psychologist (parent & teacher)
send parent adaptive rating scale; complete teacher adaptive rating scale
submit all data to School Psychologist for review
2. School Psychologist: review all and add student to SEMS print SEMS parent permission to evaluate; return folder to RTI Coordinator
3. RTI Coordinator obtains: parent permission to evaluate complete referral for Special Education Testing (SEMS Eligibility Report Tabs 1-4)
attendance and discipline records relevant medical records (optional Form 20)
coordinates classroom observation Form 7
sends completed referral packet to Director of Special Services
other relevant educational history/information
4.Director of Special Services reviews & forwards the referral to Psychological Services
5. Data requested by School Psychologist:
Attention: ECADDES
Adaptive: ABAS II
Behavior: BASC 2
Autism: ASDS / GARS 2
Other: BRIEF
6. Psychological Tests & SEMS Eligibility Student Data Section Completed
7. Psychological Report/Packet Sent to Due Process Facilitator
8. Eligibility Meeting
9. Eligibility Determined no yes, area
parent attended the meeting: yes no
parent name(s):
10. Checklist returned to Central Office
PCCSS Form 13 Last update July 2014 Page 42 of 69
43
INITIAL EVALUATION PACKET CHECKLIST (Green Sheet Form 14)
Directions: Items 1 to 5 must be completed prior to submitting the evaluation request to the Central Office; after the testi ng is
completed and the eligibility team/IEP Team has met, the completed checklist MUST be submitted to the Central Office to
document the 60 day timeline allowed by Program Guidelines. ALL MEETINGS RELATED TO THIS PROCESS WILL BE
DOCUMENTED with MEETING SUMMARY AND MEETING ATTENDANCE
Time Line Begins
Student Name:
Time Line Ends
Grade:
(completed by Central Office)
Referring Teacher:
Please arrange needed forms in the order requested
DATE: Staff : Event:
1. Vision/Hearing Screenings (Form 30)
2. RTI Data collection Tier 2 (completed by referring teacher)
Form 1 Student Proficiency Plan & Progress Monitoring Review for each area of concern
Form 2 or 3 2(academic), 3 (behavior)): Gap Analysis
Form 5 Parent contacts
Form 8 Work Sample with Cover Sheet (for each identified area of concern) Form 12 Student History (parent report)
Print out: Pre/Post Test Data; ALL available standardized test data
Attendance and discipline records
Attach: Medical or Previous Psychological records (when applicable) and/or other agency
agency reports (may use PCSS Form 20)
3. RTI Data Collection Tier 3 (completed by RTI Coordinator) SEMS Administrative Data Form
SEMS Meeting Summaries and Signature Pages for all related meetings
Use FORM 9 as template for SEMS meeting summary
Form 1 Student Proficiency Plan & Review (each identified area of concern)
Form 33 (optional) REQUEST FOR SLP/O.T./ and/or P.T. SCREEN
Form 7 Classroom Observation has been requested
SEMS Eligibility Report tabs 1 & 2
Form 21 Communication Form
Submit referral packet to School Psychologist
4. School Psychologist review all for accuracy/fidelity
Print out: SEMS Permission to evaluate
Return to: RTI Coordinator
5. RTI Coordinator Obtain permission to evaluate
Insure that classroom observation is completed
Submit referral packet to Special Education Director
6. Referral Packet sent to Special Education Director
7. Packet sent to Psychological Services
8. Data requested by School Psychologist:
Attention: ADDES 3
Adaptive: ABAS II
Emotional/Behavioral BASC 2
Autism ASDS or
GARS 2
SLD BRIEF
Other
9. Date Psychological Tests Completed & SEMS Eligibility tabs 3, 4, & 5.
10. Psychological Report/Packet Sent to Due Process Facilitator
11. Eligibility Meeting (completed SEMS Eligibility form)
12. Eligibility Determined no: date returned to SST with Form 21 yes, area Date services began:
parent attended the meeting: no yes: print parent name(s):
13. Checklist returned to Central Office
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44
RE-EVALUATION PACKET CHECKLIST (Orange Sheet)
ALL School Programs Directions: 1. Items 1 to 14 must be completed prior to submitting the re-evaluation request to the Central Office for full evaluation; Items 1 to 4 & 19 thru 21 must be completed if full evaluation is not recommended.
2. After the testing is completed and the eligibility team/IEP Team has met, the completed checklist MUST be submitted to the
Central Office.
Time Line Ends (completed by Central Office) Caseload Teacher:
Student Name:
Grade:
Homeroom Teacher
Current Exceptionality: SLD SDD MID OHI EBD S/L AUT Other:
Current Related Services: O.T. P.T. D/HH
DATE: Staff initials
Event (include all items in referral packet):
1. Vision/Hearing Clearance FORM 30
2. Last Psychological (actual date on last Psychological report)
3. Previous redetermination/eligibility meeting (NOT the current redetermination date)
4. Evaluation Review Meeting to determine re-evaluation needed (SEMS) Additional Testing Recommended yes no (if no, go on to 20/21)
5. If yes, Parental Permission to Evaluate SEMS Form
6. Referral for Special Education Testing- SEMS ELIGIBILITY Form sections: 1-4 Student / Interventions / Progress / Results
7. Social History / Student Background (FORM 12)
8. Parent Contact Information (SEMS Communication Log or PCSS FORM 5)
9. Student Work Samples w/attached checklist (FORM 8)
10. Structured Observation (FORM 7)
11. Medical records (when applicable; may use FORM 20 or Other relevant data (related services, inter-agency involvement, etc)
12. For the following areas of disability include:
For OHI:
ADDES 3
OR BASC-2 do
both teacher &
parent forms
FORM 20
For
MID/SDD:
FORM 17 informal
adaptive rep
AND ABAS
II parent &
teacher
For EBD:
teacher &
parent
BASC-2
For Aut: ASDS
OR
GARS
AND
BASC 2
For SLD:
BRIEF
(all grade
levels):
teacher &
parent
rating
For additional area of
suspected disability or
change in disability:
Tier 2 Forms
Proficiency Plan &
Progress Monitoring
13. Attach the following: SEMS Re-evaluation Determination Conference
Current IEP up to date attendance & discipline records
PCSS FORM 34 (Special Education Data Collection Sheet) data from IEP Goal monitoring
SEMS Eligibility Report most recent grade reports most recent post test data
14. Packet sent to Central Office
15. Referral Packet sent to Psychological Services
16. Psychological Testing Completed / SEMS ELIGIBILITY section: Student Data
17. Psychological Report/Packet sent to DPF and/or
18. Eligibility Meeting SEMS ELIGIBILITY Form sections: Factors/Decision Making/Team
19. Continued Eligibility Determined: no yes, area parent attended the meeting: yes no parent(s):_
SEMS administrative data re-evaluation dates (current & 3-years due) are updated
20. IF Student no longer qualifies, return the communication FORM 21 to SST
21. Checklist returned to Central Office
Extenuating Circumstances (if passed due date, explain):
Last update July 2014 Page 44 of 69
45
INITIAL EVALUATION PACKET CHECKLIST (Green Sheet – Private Schools) 1. Items 1 to 10 must be completed prior to submitting the evaluation request to the Central Office.
2. After the testing is completed and the Eligibility/IEP Team has met, the completed checklist MUST be submitted to the Central
Office to document the 60 day timeline allowed by Special Education Program Guidelines. ALL MEETINGS RELATED TO THIS
PROCESS WILL BE DOCUMENTED with MEETING SUMMARY AND MEETING ATTENDANCE
Time Line Begins
Student Name:
Time Line Ends
Grade:
(completed by Central Office)
Referring Staff: Arrange needed forms in the order requested
DATE: Staff : Event:
1. Vision/Hearing Clearance (FORM 30 or community based form)
2. Referring Teacher RTI Tier 2 Data collection
FORM 1 Student Proficiency Plan & Progress Monitoring
FORM 2 (academic), 3 (behavior), or FORM 4 (pre-k-k): Gap Analysis
FORM 5 Parent Contact Log
FORM 8 Work Samples
FORM 9 Meeting Summaries
FORM 12 Parent Report (Social History)
Print Out of all available standardized test data & most recent grade reports
3. RTI Coordinator Tier 3 Data Collection
FORM 1 Continue Student Proficiency Plan & Progress Monitoring
FORM 2 (academic), 3 (behavior), or FORM 4 (pre-k-k): Gap Analysis
FORM 6 Administrative Data
FORM 9 Meeting Summary & Notes with Meeting Attendance
FORM 11 Referral for Psychological Evaluation
FORM 33 Optional referral for O.T./P.T./SLP screening or evaluation
Attendance and discipline records
When applicable, medical or previous psychological records and/or other outside agency
reports (may use PCSS FORM 20)
8. Referral Packet sent to School Psychologist for review OR call to meet & review
9. School Psychologist review, add to SEMS; print parent permission to evaluate & return to referring staff
10. RTI Coordinator obtain: Obtain parent permission to evaluate & send referral packet to Special Education
Director
11. RTI Coordinator completes Classroom Observation (FORM 7) & forwards to School Psychologist.
12. Special Education Director sends referral to Psychological Services
13. Data requested by School Psychologist:
14. Date Psychological Tests & SEMS Eligibility tabs 1-5 Completed
15. Psychological Report/Packet Sent to Due Process Facilitator
16. Eligibility Meeting (completed SEMS Eligibility form)
17. Eligibility Determined no yes, area Services began: Parent(s) attended the meeting: no yes: print parent name(s):
18. Checklist returned to Central Office
Extenuating Circumstances:
Last update July 2014 Page 45 of 69
46
Putnam County Schools
Informal Adaptive Behavior Report
Student: Grade:
Teacher: Date:
Adaptive behavior is a developmentally determined set of coping skills. Deficits in adaptive behavior are
defined as significant limitations in a student’s effectiveness in meeting age and/or culturally appropriate
standards of maturation, learning, personal independence, social responsibility, and home, school, or
community performance. In each space for each area, circle strength or weakness; if you circle weakness in any
area, you must ALWAYS make notes related to the educational impact.
Independent Function (feeding, dressing, personal hygiene, grooming, etc)
Circle one: Strength Weakness
If weakness, describe educational impact:
Physical/Motor Function (sitting, standing, locomotion, object manipulation, handwriting, etc)
Circle one: Strength Weakness
If weakness, describe educational impact:
Communication (receptive or expressive language and overall ability to relate needs, wants, feelings)
Circle One: Strength Weakness
If weakness, describe educational impact:
Socialization (interactions with others, reactions to authority, ability to follow rules)
Circle One: Strength Weakness
If weakness, describe educational impact:
Self Direction/Pre Vocational (responsibility, personal initiative, coping skills, understanding the use of money/time)
Circle One: Strength Weakness
If weakness, describe educational impact:
PCCSS Form 17 Last update July 2014 Page 46 of 69
47
Putnam County Charter School System
Checklist for Screening Request
Student: Grade: School:
Referring Staff: Student’s Homeroom Teacher:
Educational Screenings are for informational purposes only and will not result in eligibility consideration.
Date: Staff: Item:
Form 22 Parent Permission for Screening
Form 12 Child History/Parent Report
Educationally relevant medical information (i.e. ADHD diagnosis)
Form 20 Medical Verification
School based standard assessment data (i.e. ITBS; CoGat)
Send screening referral to PCSS School Psychologist
Information requested by School Psychologist
Screening Completed
Screening report returned to referring staff
Parents contacted with results and consultation
PCSS Form 18
Last update July 2014 Page 47 of 69
48
CHECKLIST for 504 Consideration/Review/Re-evaluation
ALL School Programs Directions: After the process is completed, the completed checklist MUST be submitted to the Central Office.
Student Name: Grade: 504 Coordinator: _Homeroom Teacher:
Check One: Initial request:
Annual Review: Re-evaluation:
DATE: Staff initials
Event (include all items in referral packet):
1. Request/Permission to Evaluate PCCSS Form 22 Targeted Screening
2. Vision/hearing Screening Permission (PCCSS Form 30) signed by parent/caregiver
V/H signed permission sent to R. Moreland
Vision/Hearing Screen completed (**may be from outside source)
3. 504 Coordinator adds student to SEMS completes SEMS Administrative Data form
requests Social History / Student Background (PCCSS Form 12)
forwards request/permission PCCSS Form 22 and Social History (PCCSS Form
12) to School Psychologist
School Psychologist 4. completes targeted screening / attaches report to SEMS
report forwarded to 504 Coordinator
5. 504 Coordinator
coordinates meeting with parent/caregiver to review screening results
completes SEMS Meeting Summaries & Attendance for all related meetings begins Section 504 Evaluation/Reevaluation Review PCCSS Form 23 Sections one through seven insuring the following is collected/completed:
SEMS Communication Log; or Parent Contacts PCCSS FORM 5
Student Work Samples in identified area of concern (PCCSS FORM 8)
Medical records PCSS FORM 20 (must be current within 1 year (initial referrals)
available assessment information
6. The 504 Coordinator establishes a meeting and insures: parents/caregivers and appropriate staff are notified (PCCSS Form 24 notice of
504 meeting)
7. parent attended the meeting: yes no parent(s): Parent rights distributed: yes no
8. SEMS Meeting Summary & Attendance are completed
9. 504 Eligibility established: yes no
if yes, continue;
if no, change SEMS entry for this student to not eligible and go to #13
10. 504 Coordinator
completes SEMS Accommodation Plan insuring that parents & appropriate
distributes plan to appropriate staff
delivers copies to appropriate staff
sets date for review meeting
11. This checklist returned to Central Office: Attention Laura Melton
Last update July 2014 Page 48 of 69
49
Medical Evaluation Report Student: DOB:
PRINT Physician/Psychologist:
Date of Medical Evaluation: OR (for ADD/ADHD ONLY)
Licensed Psychologist (outside the school system):
1, Diagnosis/prognosis of health impairment:
2. Information regarding the effects of the chronic or acute health problem on strength, vitality, and/or alertness of the student in the educational environment (including a heightened awareness to environmental stimuli that results in limited alertness with respect to the educational environment).
3. Medication(s) prescribed and dosage(s):
4. Information on any special health care procedures required for the student or special diet needs:
5. Information regarding any medical restrictions or activity which may affect the student’s performance in the educational environment:
6. Other relevant information:
(Signature of Physician / Licensed Psychologist) Date
Address: Phone #
Fax #
Last update July 2014 Page 49 of 69
50
PCSS Communication Form Page 1 of 2
For initial referrals: Upon decision to refer a student for evaluation, SST will complete section 1 of this
form and place it in the referral folder. Upon completion of the Eligibility Meeting, the person
coordinating the Eligibility Meeting will complete Section 2 and then return this form to the SST
Coordinator who will then schedule an SST review.
For re-evaluations: Upon completion of the Eligibility Meeting during which the student is found no longer
eligible, the person coordinating the Eligibility Meeting will complete Section 2 and send this form to the SST Coordinator who then schedules an SST
review.
For related services: Upon completion of the Eligibility meeting during which a related service observation or
evaluation is recommended, the person coordinating the Eligibility Meeting will complete
Section 2 and deliver a copy of this form to the related service provider (speech, occupational
therapy, physical therapy)
For reconsideration of eligibility: The student was evaluated, found not eligible, and was returned for Tier 3 monitoring. Tier 3 monitoring over a period of one full quarter has resulted in additional information. Tier 3 completes Section 3: see page 2
SECTION 1 On this date: ,
the Student Support Team has referred:
, (Student) (grade)
for a comprehensive psycho-educational evaluation.
SECTION 2 On this date: _,
(date of eligibility meeting) the Eligibility Committee has found this student: Eligible for Specialized Instruction in the area of:
Greatest educational impact in what subject(s):
With a recommendation for:
full inclusion partial inclusion (# of hours ) consultative only resource room separate class out of school placement Not Eligible OR No longer Eligible for
Specialized Instruction with a recommendation to: continue Tier 3 Interventions continue Tier 2 Interventions develop a 504 Plan
This student may require a related service observation or evaluation for:
Speech Occupational Therapy Physical Therapy Behavioral Therapy
other:
SECTION 3 On this date: , the Eligibility Committee has reviewed additional information and made the following determination:
Eligible for Specialized Instruction in the area of: Greatest educational impact in what subject(s):
With a recommendation for: full inclusion partial inclusion (# of hours __) consultative only resource room separate class out of school placement
Not Eligible OR No longer Eligible for Specialized Instruction with a recommendation to: continue Tier 3 Interventions continue Tier 2 Interventions
develop a 504 Plan other:
Last update July 2014 Page 50 of 69
51
Page 2 of 2 For reconsideration of eligibility: The student was evaluated, found not eligible, and was returned for Tier 3 monitoring. Tier 3 monitoring over a period of one full quarter has resulted in additional information. Tier 3 completes Section 3: request for Eligibility Committee review.
To request an Eligibility Committee review, the following information must be submitted:
new parent permission to evaluate interventions and progress monitoring data collected since the last eligibility meeting check to insure vision/hearing is current updated work samples/observation any additional medical information most recent CRCT; or other standard test measures
Last update July 2014 Page 51 of 69
52
Putnam County Charter School System
158 Old Glenwood Springs Rd. Eatonton, GA 31024
Parental Consent for Academic and/or Behavioral Screening
Academic and/or Behavioral Screening is being requested by (check one): Parent Teacher SST Physician other:
School:
Primary Elementary Middle High other:
Due to concerns regarding (check all that apply):
academic progress for: reading math language listening oral expression
speech O.T. P. T.
Behavior* inattention impulsivity hyperactivity aggression
other:
* if behavior is checked, please request BASC 2 or ADDES 2 from at least 1 teacher/1 parent
Dear Parent or Legal Guardian of / DOB / His/her current homeroom teacher is: Your student was referred for individual educational and/or behavioral screening. Screening may include brief classroom
observations and/or individual tests that may offer more information about how to better meet your student’s
educational needs. Screening results will be reviewed with you and, with your further permission, may or may not result
in a recommendation for a full evaluation. If you have any questions about the screening process, please call your
student’s school. Screening results alone cannot be used to make educational decisions or alternative educational
placement. If you agree to have this screening done, please sign below.
Thank you for your cooperation.
Sincerely,
yes, I agree for Putnam County Charter School System to screen my student for academic and/or behavioral
concerns. no, I do not agree for the following reasons:
Signature of Parent/Guardian/Surrogate: Date: Contact info (phone or email):
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Putnam County Charter School System SECTION 504 EVALUATION/REEVALUATION REVIEW MEETING
and 504 PLAN ELIGIBILITY DETERMINATION
SECTION 1: Demographics
Student: Grade: Date of Birth:
School: Homeroom Teacher:
History of Retention: never retained retained once multiple retentions
Does language impact academic performance? Yes/No
Language spoken:_ Language at home:
ESOL services: yes/no
Vision/hearing screening completed & documented?
SECTION 2: Purpose
Date:
Date of 504 Meeting: Time:
Place: School Room #:
Parent Concerns:
Parent Permission to evaluate signed: Yes/No
Reason for the meeting: Initial 504 Consideration Review Re-evaluation
Parent response to Meeting Notice: will attend will not attend no response
Items provided to the parents: notice of the 504 Meeting (PCCSS Form 24)
notice of 504 Intent to Evaluate Parent/Guardian Procedural Safeguards
SECTION 3: Academic Data Collected & Reviewed (complete sections applicable to this student; delete or cross out others)
Area measured Scores/Instrument percentiles Age/grade equivalent
Current grades
Basic Reading
Reading Comprehension
Basic Math
Math Reasoning
Language Arts
Social Studies
Science
Academic Data collected indicates the following academic improvement is evident some improvement
no improvement sudden drop in academic performance
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SECTION 4: Behavioral Data Collected & Reviewed (applicable/not applicable) Does this student have behaviors that disrupt or adversely affect the education of the student
or others? Yes/No Describe the specific behaviors:
List disciplinary actions to date:
SECTION 5: Evidence of physical or mental impairment Yes/No Describe below:
SECTION 6: Are there school attendance issues (truancy; excessive tardiness)? List:
SECTION 7: Other relevant information:
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SECTION 8: 504 Eligibility and Plan Determination A. Based on the above information drawn from multiple sources, the 504 Team answers the
following questions: a. Does the student have a physical or mental impairment?
i. If yes, continue ii. If no, the student is not eligible (go to SECTION 9)
B. Does the physical or mental impairment substantially limit a major life activity? Yes/No
a. Considerations: i. As a result of this impairment, the student cannot perform a particular major life
activity in a manner comparable to same age/grade peers ii. Mitigating measures are not considered (decision is made as if the student were
NOT using mitigating measures) except eye glasses or contacts iii. A disability that is episodic or currently in remission, does not preclude an
eligibility finding if the impairment would substantially limit a major life activity when active
C. Documentation that supports the finding of ‘substantial limitation’:
SECTION 9: DETERMINATION OF THE 504 TEAM: In any event where services are not needed, it is understood that the student is protected by Section 504’s anti discrimination provisions. The student cannot be discriminated against the student on the basis of the disability.
o The student is not disabled because there is no physical or mental impairment that
substantially limits a major life activity. o The student is disabled because there is a physical or mental impairment that substantially
limits a major life activity and services are needed to insure that the student’s educational needs are adequately met. An accommodation plan will be developed.
o The student is disabled because there is a physical or mental impairment that substantially limits a major life activity but services are not needed because the student’s educational needs are met as adequately as those of nondisabled peers; no services are needed. For disabilities that are episodic: the student is disabled because there is an episodic physical or mental impairment that, when active, substantially limits a major life activity, and services are needed in order that the student’s educational needs are met as adequately as those of disabled peers. A 504 Plan will be developed that will be implemented when the impairment is active. When the impairment is inactive, the 504 Plan will not be implemented.
o For disabilities that are in remission: The student is disabled because there is a physical or mental impairment that is in remission but, when active, substantially limits a major life activity,
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and services are needed in order that the student’s educational needs are met as adequately as those of nondisabled peers. The need for a 504 Plan will be addressed if/when the impairment comes out of remission.
Determination upon re-evaluation:
Based upon re-evaluation data, the student continues to be disabled under Section 504 because there is a physical or mental impairment that substantially limits a major life activity. The 504 Plan will be reviewed or revised.
Based upon re-evaluation data, the student no longer is disabled under Section 504 because there is not a physical or mental impairment that substantially limits a major life activity. A 504 Plan is no longer needed.
The following 504 Team Members acknowledge by signature that they have participated in this evaluation review meeting and eligibility determination:
Name (PRINT) Signature Position
Original: to 504 Folder Copies: to parent (along with 504 Procedural Safeguards)
Attach to SEMS
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Putnam County Charter School System
Special Programs 158 Old Glenwood Springs Road
Eatonton, GA 31024
Phone: (706) 485-6390
Fax: (706) 485-3707
Date:
Dear Physician:
The Putnam County Charter School System recently completed a psychological and educational evaluation on
. Results of the evaluation indicate that the student is experiencing difficulty in
the following areas: We would like for you to review the enclosed evaluation results in order to determine if there is a medical condition that
may be interfering with the student’s success in the educational environment. After reviewing the evaluation results,
please complete the enclosed medical evaluation report if you feel that there is a chronic or acute health problem that may
affect the student’s performance in school. The school system will use this information to determine eligibility for
individualized program services.
Thank you for your cooperation in providing the school system with the requested information. If you should have any
questions, you may contact the Special Programs office at the number listed above to discuss this request.
Sincerely,
Director of Special Programs
Enc.
PCCSS Form 28 Physician Letter
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Putnam County Board Of Education Program for Exceptional Children
158 Old Glenwood Springs Rd. Eatonton, Ga. 31024
Phone: (706) 485-5381
Fax: (706) 485-3707 // Authorization to Release Confidential Information
I hereby authorize the Putnam County Charter School System to release the confidential
records of my student, , date of birth and
request that the records be sent to:
The following records are requested:
Social History Psychological/Educational Evaluation Individual Education Plan Eligibility Report Summary of Current Services Any/All Pertinent Information
The records requested will be used to determine appropriate educational services and the least restrictive environment in which services can be provided. I understand that the Putnam County Board of Education will not release these records to a third party.
I understand and agree with the above statements.
(Parent/Legal Guardian Signature) Date
(Witness Signature) Date
*Authorization to be kept on file.
In compliance with federal law, including provisions of Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990, the Putnam County Charter School System does not discriminate on the basis of race, sex, religion, color, national or ethnic origin, age, or disability in its administration of education policies, programs and activities or in employment.
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Putnam County Charter School System page 1 of 2
158 Old Glenwood Springs Road Eatonton, GA 31024
Parental Consent for Hearing/Vision Screening
Student’s Name Date
Teacher’s Name Grade
Dear Parent/Legal Guardian/Surrogate Parent,
We are requesting your permission to conduct a Hearing and Vision Screening We would like to
conduct this screening to gather more information about how to better meet your student’s needs. The screening will be handled by the school system’s Hearing and Vision Coordinator, Mrs. Regenia Moreland. If you have any questions about this screening, please contact your student’s school.
Please sign below to let us know whether or not you agree for this screening to take place. Return this letter to within five days. If you do not return this form within five days, we will contact you about your decision.
Thank you for your cooperation.
Sincerely,
Yes, I agree for the Putnam County Charter School System to conduct a hearing/vision screening for my student.
No, I do not agree for the following reasons:
Signature of Parent/Guardian/Surrogate Date
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Putnam County Schools page 2 of 2 Vision/Hearing Report
Student’s Name DOB
Teacher Grade School
Date of Parent Permission
VISION SCREENING
Near Point Far Point
Examiner Date passed failed passed failed
Examiner Comments:
Examiner Date passed failed passed failed
Examiner Comments:
HEARING SCREENING
Examiner Date passed failed
Examiner Comments:
Examiner Date passed failed
Examiner Comments:
PCCSS Form 30
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Putnam County Board Of Education
Program for Exceptional Children
158 Old Glenwood Springs Rd.
Eatonton, Ga. 31024
Phone: (706) 485-6390
Fax: (706) 485-3707 // Authorization to Receive Confidential Information
I hereby authorize (School/Agency Name)
to release the confidential records of my student,
(Student’s Name)
, DOB
and request that the records be sent to:
Putnam County Board of Education Program for Exceptional Children
158 Old Glenwood Springs Rd
Eatonton, Ga. 31024
The following records are requested:
Social History
Psychological/Educational Evaluation
Individual Education Plan
Eligibility Report
Summary of Current Services
Any/All Pertinent Information/Medical reports Doctor’s Orders for OT/Speech/PT
The records requested will be used to determine appropriate educational services and the least restrictive environment in
which services can be provided. I understand that the Putnam County Board of Education will not release these records to
a third party.
I understand and agree with the above statements.
(Parent/Legal Guardian Signature) Date
(Witness Signature) Date
*Authorization to be kept on file.
In compliance with federal law, including provisions of Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990, the Putnam County Charter School System does
not discriminate on the basis of race, sex, religion, color, national or ethnic origin, age, or disability in its administration of
education policies, programs and activities or in employment.
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Putnam County Board of Education
Physical/Occupational Therapy Referral Information Sheet
To be completed by referring teacher.
The student’s parents should be consulted by the referring teacher before any referral procedures are initiated.
Please complete this form and forward to Laura Melton. When the parental consent for evaluation is returned, you will be
contacted regarding an evaluation date.
Student’s Name: Age: DOB:
School: Grade:
Referring Teacher: Special Ed. Program (when applicable):
Parent/Guardian: Home Phone:
Parent’s Address:
Date Parent Notified: Work Phone:
This referral was initiated primarily due to: Teacher’s Concern: Parent’s Concern:
What other services does the student receive?
Are you aware that the student has had or presently has any medical problems?
If yes, please explain to the best of your knowledge.
List the educational short-term objective(s) from the student’s IEP which you feel cannot be met without the support of a
related service. (This information is required if the student is currently receiving special education services.)
Signature of Referring Teacher Date Laura Melton, Director of Special Programs Date
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Special Education Data Collection and Progress Monitoring Form (IF computer program printouts with the same data are not available)
Area of difficulty: Grading Period:_ 9 weeks
IEP Objective:_
Criteria:
EACH IEP Goal must have a minimum of monthly data collection points from the inception of the current IEP:
Date: Score/Grade: General Class average Progress toward promotion criteria: Yes/no
Teacher comments (optional: may include the back side of this page):
Putnam County Charter School System page 1 of 2
Eatonton, GA 31024
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FUNCTIONAL BEHAVIORAL ASSESSMENT
Initial Plan: / Revision:
Student Name:
DOB:
Grade:
Teacher:
School: PPS /PES /PMS
/PHS
Other:
Gender: male / female Primary Language:
Behavior(s) of Concern:
(must be stated in
1. MEASURABLE terms
2. OBSERVABLE terms
1.
2.
Previous Interventions: (check all that apply)
Removal from situation Seating change
Parent conference
Detention Mentoring/tutoring
Administrative action Point sheets/strike sheets
Modified work Extra assistance
Behavioral contract Added to IEP goals
Counseling with school counselor
Counseling with community
counselor
Referral to SST Individual incentives
Other: list
Previous history relevant to current behaviors:
Data Collection Methods: Review of school records Review of medical records
Informal assessments
(subjective reports)
Formal/standardized
assessments
Review of office referrals Screenings
Interviews
Classroom observations
Review of point and or strike sheets Other:
Signature of Staff Involved in FBA: 1.
2.
3.
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Page 2 of 2
Data for identified behavior:
Intensity:
Frequency:
Duration:
Other relevant information:
Data for identified behavior:
Intensity:
Frequency:
Duration:
Other relevant information:
Triggers (what happens to set off the behavior):
Teacher reprimand
Negative attention
Teasing by peers Transition time
Possible Sensory overload
Contributing Factors (anything that might be impacting the behavior):
Change in routine
Environmental stimuli Home problems
Peer interactions Other
Response to Behavior (what happens directly after the
behavior occurs?) Move closer to teacher
Increased adult supervision
Student interview
Supplemental service (call in
counselor/administration)
Removal from setting
Other:
Function of the Behavior (what does the student gain or get
out of the behavior?) Attention
Control
Object and/or activity Attempt to communicate needs
Sensory stimulation Other:
Possible Reinforcers (student may respond to ??)
Tangible items (stickers, smiley faces, etc) Edible (ice cream, snack time)
Peer association (time with ---) Adult association (time with ---)
Special activity Good note home
Phone call home
Item from school store Homework pass
Lunch with ----- Teacher helper; class leader
Free time for -----
Other:
Strengths/Interests of this student: 1.
2.
3. 4.
5.
Student’s best school subject(s):
Student’s most difficulty subject(s):
PCCSS Form 36
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APPENDIX B
Web Resources
Readworks.org
Discipline Help: You Can Handle Them All: http://www.disciplinehelp.com/
Do What’s Right: http://dww.ed.gov
Intervention Central website: http://www.interventioncentral.org
Florida Center for Reading Research: www.fcrr.org
Oregon Reading First: http://oregonreadingfirst.uoregon.edu/
Pikes Peak Literacy Strategies Project: www.pplsp.org
What Works Clearinghouse website: www.w-w-c.org
Recognition and Response: http://www.recognitionandresponse.org/
RTI Action Network http://www.rtinetwork.org/
The Center for Data Driven Reform in Education http://www.cddre.org/
National Center for Student Progress Monitoring http://www.studentprogress.org/default.asp Office of Special Education Programs (OSEP) - Responsiveness to Intervention in the SLD Determination Model:
http://www.osepideasthatwork.org/toolkit/ta_responsiveness_intervention.asp
National Center on Response to Intervention
http://www.rti4success.org/
Advances in Progress Monitoring – University of Minnesota
http://cehd.umn.edu/EdPsych/SpecialEd/CBMConference/handouts.html
Response to Intervention and Positive Behavior Supports - OSEP
http://www.pbis.org/
whatworksclearinghouse.com
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APPENDIX C
RTI In Action Source: RTI Guide for Parents at www.ncld.org
► Paul is a first grade student. At the beginning of the school year, Paul’s score on the universal screening fell below the
school’s cut-point to identify students at-risk for reading failure. At the end of 5 weeks, Paul’s scores on the curriculum
based word identification fluency measurement fell below the performance needed to indicate a positive response. So,
Paul was considered unresponsive to Tier 1 general education [the core] and in need of additional support.
► The school met with Paul’s parents. During the meeting, they explained Paul’s scores and their concern. Paul entered preventative tutoring - - Tier 2 of the school’s RTI program. Paul’s parents received a detailed written
intervention plan. [BCPS: Student Proficiency Plan (Form 1)]
► Paul received preventative tutoring four times a week for 45 minutes per session, in a small group with two other
students. Weekly monitoring (Form 2) was shared with Paul’s parents. They were also advised that they could request a formal evaluation under the IDEA if they suspected that Paul might have a disability. [Reminder at this point: Even though a parent has the right at any time to request an evaluation, research states that RTI interventions be administered
with fidelity. If an intervention that is being attempted is unsuccessful, the school should quickly move to another
intervention. RTI is NOT the road to special education. RTI looks at the core instructional program and appropriate
movement throughout the Tier levels.]
► After 8 weeks under Tier 2, Paul showed progress exceeding the school’s expectations. He returned to Tier 1 general
[core] instruction, with the hope that he would now progress adequately. The school continues to monitor his progress
weekly. [Also, if an intervention is working, continue with it.]
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Planning Process Flow Chart
Does the student have an IEP?
Yes No
Do the IEP goals and benchmarks cover the deficits identified by district learning
checks?
Proceed to problem-solving
process
Yes
Proceed to the problem-solving process to review IEP goals and
objectives; no need for SPP
No
Does the student qualify in an area which would allow specially designed instruction in the area
of deficit identified by the district learning check?
Yes No
Review IEP goals and objectives
and consider revising IEP by adding specially designed
instruction.
Proceed to problem-solving
process; student is considered for SPP
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All students are benchmarked
using the district learning check
measurement procedures.
Data is reviewed and At-Risk
students are identified using cut-
off scores established by the
district.
School problem-solving teams
review assessment data on all
identified At-Risk students
If the student is identified as At-Risk
on the next benchmark, the team
should consider a SPP
No need to develop NO Student
Proficiency Plan
(SPP)
Does the diagnostic and classroom
data support the identification of
the At-Risk student?
Using diagnostic data, the problem-solving team identifies the specific skill
deficit and matches intervention to skill deficit. Document on SPP
Yes
1. SPP completed, intervention implemented,
and progress monitoring is completed for at
least 4-6 weeks
2. Revise SPP and implement a 2nd
intervention, monitor progress
When the team meets to
review the data, is the
student progressing?
NO
YES
Continue
intervention and
continue to monitor Or
Return to Previous
Tier
3. The team initiates Tier III intervention
4. Revise SPP and implement a
2nd Tier III intervention
Special Note:
Steps 1-4
above are
followed
sequentially
If interventions have been completed in Tier II and Tier III
and the student does not make adequate progress, a Special
Education Referral may be considered
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